Characteristic of Newborn

The end of our journey has come afer 40 weeks. The fruit ofyour labour (literally) will soon be in your hands.
There are afew things you might want to know about your new arrival. Typically, a newborn baby has the following
characteristic appearance:
Welght: Average 2.8 kg for Indian babies (range 2.5-3.2 kg). Babies below 2.5 kg at birth are considered
to be low birth weight and need special evaluation.
Length: Approximately 50 cm. Remember, small women have small babics and many genctic factors also
play a role in determining the length of the baby.
Head: Your baby's head appears large for the body and may have an clongatcd shape or appear to have
some "bumps'. This is due to changes called molding. which occurs in labour and delivery. Small bumps
called 'caput' usually disappcar in I -2 days. Soon the head gets rounder. The head circumference is 33-
cm.
Soft spots or Fontanelles: There are 2 areas on the head where bone formation is incomplete at birth. The
larger one, in front of the head closes by 6- 18 months. The smaller one at the back usually closes by 6
weeks.
Hair: As all people vary. so does their hair. Your baby may have lots of hair or none at all! It depends on
familial and racial lactors.
Heart beats: Usually the heart rate is 120- 140 beats per minute.
Respiratory rate (breathing): It is faster than adults, usually 30-40 breaths/ minute. Breathing may be
noisy or stop for many seconds. This is not uncommon.
Colour: Depending on the parents, the skin colour of newborn varies. In general, newborn babies look
flushed and pink all over. However, the palms and soles of the feet may look dusky or little bluish soon
afterbbirth.

Axillary temperature measurememt. The thermometer should remain in place for 3 minutes. The nurse presses the
newborn's arm tightly but gently against the thermometer and the newborn's side, as illustrated

Proper Identification of the Newborn

>Proper Id is made in the delivery room before mother and baby are separated.
o Identification Band
Footprinls
Others-fingerprints, crib card, bead bracelet
*Birthcertificate
final identification check of the mother and infant must be performed before the infant can be allowed to
the discharge to ensure that the hospital is discharging the right infant.
leave hospital upon
Preventing Infection
Credes Prophylaxis- Dr. Crede
prevent opthalmia neonatorum or gonorrhoeal conjunctivitis
how transmitted - mom with gonorrhea

drug: erythromycin ophthalmic ointment- inner to outer

I t is part of the routine care of the NB to give prophylactic eye

treatment against gonorrheal conjunctivitis or ophthalmia
neonatorum within the first hour after delivery.
Neisseria gonorrhea, the causative agent.maybe passed on to the
fetus when infected vaginal and cervical secretions enter the eyes as
the baby passes the vaginal canal during delivery. This practice was
introduced by Crede, German gynecologist in 1884. Silver Nitrate

Ophthalmia neonatorum
Any conjunctivitis with discharge occuring during the first two weeks of life. It typically appears 2-5 days
after birth, although it may appear as carly as the first day or as late as the 13th.

silver nitrate (used before) - 2 drops lower conjumctiva (not used now)

Adminlstering Erythromyeln or Tetracycline Ophthalmle Olntment

These ointments are the ones commonlyused nowadays for eye prophylaxis because they do not cause eye
irritation and are more cffective against Chlamydial conjunctivitis.
>Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes.
+Wipe excess ointment after one minute C sterile cotton ball moistened C sterile water.

Principles of cleanliness at birth: Handwashing

Clean hands Before entering the nursery or caring for a baby
> Clean perineum >In between newborm handling or after the care of
* Nothing unclean to be introduced into the vagina eachbaby
+ Clean delivery surface *Before treating the cord
Cleanliness in cutting the umbilical cord Ater changing soiled diaper
+ Cleanliness for cord care of the newborm baby >Before preparing milk formula.
Preventing Hemorrhage
A s a preventive measure, 0.5mg (preterm) to I mg (full term) Vit. K or Aquamephyton is injected IM in the
NB'S vastus lateralis (lalcral anterior
thigh muscle
+Vit-k-to prevent hemorrhage RIT physiologic hypoprothrombinemia
Aquamephyton. phytomenadione or konakion
> I m l term IM, vastus lateral or lateral ant thigh
05 ml preterm baby
> VitK- synthesized by normal flora of intestine
V i t K-meds is synthetic due intestine is sterile
Procedure for vitaminK injection. Cleanse area thoroughly with alcohol swab
and allow skin to dry. Bunch the tissue of the upper outer thigh (vastus
lateralis muscle) and quickly inserta 25-gauge S/8-inch needle at a 90-degree
angle to the thigh. Aspirate. then slowly inject the solution to distribute the

medication evenly and minimize the baby's discomfort. Remove the necdle
and gently massage the site with an alcohol swab.

Care of the Cord

The cord is clamped and cut approx. within 30 sec after birth. In the
DR, the cord is clamped twice about 8 inches from the abdomen and
cut in between.

When the NB, is brought to the nursery, another clamp is applied. to I in from the abdomen and the
cord is cut second time.
a

The cord and the area around it are cleansed w/ antiseptic solution.
The manner of cord care depends on hospital protocol or the discretion of the birth attendant in home
delivery, what is impt. Is that principles are followed.
Cord clamp is removed after 48 hours when the cord has dried. The cord stump usually dries and falls
off within 7-10 days leaving a granulating area that heals on the next 7-10 days.
Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and
seperates more rapidly if it is exposed to air.
Report any unusual signs & symptoms that indicate infection:
Foul odor in the cord
Presence of discharge
Redness around the cord
The cord remains wet and does not fall off within 7-10 days
Newborn fever

"Tetanus microorganism thrives in anaerobic environment so you actually prevent infection if

cord is exposed to air".
cleans in communlty
clean hand
clean cord
clean surface
betadine or povidone iodine - to clean cord

check AVA. then draw 3 vessel cord

If2 vessel cord- suspect kldney malformatlon

leave about 1" ofcord
If BT or TV Infuslon -leave 8" of cord best access no nerve
check cord every 15 min for la6 hrs- bleeding> 30 ce of blood bleeding of cord- Omphalagla-
Suspect hemophilia
Cord turns black on 3rd day & fall 7-10 days
Faiture to fall after 2 weeks- Umbilical granulation
Mgt: silver nitrate or catheterization
clean with normal saline solution not alcohol
don't use bigkis- air
persistent moisture-urin, suspect patent uracus fistula bet bladderand normal umbilicus
dx: nltrazlne paper test - yelloW- urlne
mgt: surgery

Bathing
oil bath-initial
to cleanse baby & spread vernix cascosa

Fx of vemix caseosa
1. insulator
2. bacterio- static
Babies of HIV + mom -immediately give full bath to lessen transmission of HIV
13-39% possibly
oftransmission of HIV

Immediate Care of the Newborn S i g n s of potential distress or deviations from

irway expected findings
B ody temperature Asymmetrical chest movements
O Apnea>15 scconds
heck/ assess the newborn
o Diminished breath sounds
D etermine identification
Seesaw respirations
Stimulate &dry infant Grunting
Assess ABCs
o Nasal Naring
Encourage skin-to-skin contact
o Retractions
Assign APGAR scores
o Deep sighing
Give eye prophylaxis & Vit. K o Tachypnea - respirations> 60
Keep newborn, mother, & partner together o Persistent irregular breathing
whenever o Excessive mucus
Newborn Assessment and Nursing Care
Persistant fine crackles
Stridor
Physlcal Assessment
Breathing ( ventilating the lungs)
Temperature range 36.5 to 37 axillary
o check for breathlessness
Common variations
o ifbreathless, give 2 breaths- ambu bag
Crying may clevate temperature
o yr old- mouth to mouth, pinch nose
O Stabilizes in 8 to 10 hours after
O <IyT-mouth to nose
delivery o force-different between baby & child
Temperature is not reliable indicator of
O infant pufft
infection a temperature less than 36.5
Circulation
T'emp: rectal- newborn
o Check for pulslessness :carotid- adult
t o rule out imperforate anus
Brachial - infants
take it once only, I inch insertion
CPR- breathless/pulseless
Compression- inf-I finger breath below
Imperforate anus
nipple line or 2 finger breaths or thumb
1. atretic n o anal opening
CPR inf 1:5
2. agenetialism- genital
3. stenos has opening Adults 2:30
4. m e m b r a n o u s - has o p e n i n g
Blood Pressure
Onot done routinely
Earliest sign: Factors to consider
. no mecomium
o Varies with change in activity level
2. abd destention Appropriate cuff size important for accurate
3. foul odor breath
reading
4. vomitous of fecal matter o 65/41 mmHg
5. can aspirate - resp p r o b l e m

General Measurements
Mgt: Surgery with temporary colostomy o Head circumference- 33 to 35 cm
o Expected findings
Heart Ratec
o Head should be 2 to 3 cms larger than the chest
range 120 to 160 beats per minute
O Abdominal circumference-31-33 cm
Common variations o Weight range - 2500- 4000 gms (5 lbs. 8oz. - 8
Heart rate range to 100 when sleeping to 180 Ibs. I 3 oz.)
when cryng o Length range - 46 to 54 cms (19- 21 inchcs)
Color pink with acrocyanosis
Heart rate may be irregular with cryingg Anthropometic measurement
Although murmurs may be due to transitional normal length- 19.5 - 21 inch or 47.5 - 53.7Scm.

circulation-all murmurs should be followed-up average 50 cm

and referred for medical evaluation head circumference 33- 35 cm or 13- 14*
Deviation from range Hydrocephalus ->14"
Faint sound Chest 31-33 cm or 12-13
Abd 31 - 33 cm or 12- 13"
Cardiac rate: 120 - 160 bpm newborn
Apical pulse - Ieft lower nipple
Radial pulse - normally absent. If present PDA Signs of increased ICP
1.) abnormally large head
normal present. If absent- COA
Femoral pulse
coartation of aorta
- -

2.) bulging and tense fontanel

3.) increase BP and widening pulse pressure #3 & #4 are
Cushings triad of
Respiration 4.) Decreased RR, decreased PR ICP
range 30 to 60 breaths per minute
5.) projective vomiting- sure sign of cerebral irritation
 6.) high deviation - diplopia- sign of ICP older child
Common varlations
o Bilateral bronchial breath sounds 4-6 months- normal eye deviation
Moist breath sounds may be present shortly
>6 months- lazy eyes
after birth 7.) High pitch shrill cry-late sign of ICp

Skin O Jaundice is first detectable on the face (where

O Skin reddish in color, smooth and puffy at birth skin
o At24-36 hours of age. skin flaky. dry and pink
overlies cartilage) and the
mucus
membranes of the mouth and has a head-to-toc
color progressin.
Edema around eyes, feet, and genitals o Evaluate it by blanching the tip of the nose, the
o Venix Caseosa -whitish, cheese-like substance, forchead, the sternum, or the gum linc. This
covers the fetus while in utero and lubricates procedure must be done with appropriate
the skin of the NB. The skin of the term or lighting. Another are to assess is the sclera.
postterm nb has less vernix and is frequently O Jaundice maybe related to breastfeeding,

dry: peeling is common, esp. on the hands & hematomas, immature liver function, bruises
feet from forceps, blood incompatibility, oxytocin
O Lanugo -moderate in füull term; more in induction or severe hemolysis
preterm; absent in postterm; shed after 2 weeks
procesS.
in time of desquammation
Turgor good with quick recoil
o Hair silky and soft with individual strands
O Nipples present and in expected locations
Cord with one vein and two arteries
O Cord clamp tight and cord drying
Nsg Resp:
I. cover eyes prevent retinal damage
O Nails to end of fingers and often extend slightly 2. c o v e r genitals - prevent priapism - painful continuous

beyond
erection
3. change position regularly - even exposed to light
Skin color 4. increase fld intake - due prone to dehydration
White cdema Blug-cyanosis or hypoxta 5. monitor l&0- weigh baby
(Grey -infcction -Jaundice , carotcne 6. monitor V/S - avoid use of oil or lotion

duc- heat at phototherapy

ACrocyanosis
bronze baby syndrometransient
o Bluish discoloraton of the hands andfeet maybe S/E of phototherapy
present in the first 2 to 6 hours after birth
O This condition is caused by poor peripheral
Care of Newborn in Jaundice
circulation, wie results in vasomotor instability &
Phototherapy
capillary stasis, esp. when the baby is exposed to
o Is the exposure of the NB to high intensity
cold.
light.
fthe central circulation is adequate o Maybe used alone or in conjunction w
the blood supply should return quickly
exchange transfusion to reduce serum bilirubin
when the skin is blanched with a
finger. Blue hands and nails are poor
levels.
o Decreases serum bilirubin levels by changing
ndicator of oxygenation in NB. The
nurse should assess the face & mucus bilirubin from the non-water soluble form to
membranes tor pinkness retlecting water-soluble by products that can be excreted.
dcquate oxygenation
Nursing Interventions:
1. Exposing as much of the NB's skin as possible
Mongolian Spots
Patch of puple-black or blue-black
however genitals are covered & the nurse monitors the
color distnbuled over coceygeal and
genitals area for
sacral regions of infants of African- skin irritation
American or Asian descent. Not 2. Eyes are covered with patches or eye shields and are
malignant. Resolves in time. They removed at least once per shift to inspect the eyes
gradually fade during the first or 3. Monitor temp. closely & luids to compensate water
second year of lite. They maybe
loss
mistaken for bruises and should be
documented n the NE's chart.
4. NB is repositioned q2° and stimulation is provided.
N B will have loose green stoolsand green
colored urine.
Mottling Exchange Transfusion
pattern
nder
ofdilated
the skin
blood vessels
O ls the withdrawal and replacement of newborn's
Tesult of general blood with donor blood.
rculation tluctuatons. It may last
hours
Fveral to sevetracS r

ay come and go periodically l a which are exposed to

ottling maybe related to chilling
prolonged apnea. ebaceous glands, apper as
ised white spots on the tace, esp.
ross the nose. No treatment is
Physlologle Jaundice cessary, because they will
car within first month.
O Hyperbilirubinemia not associatcd with
Infants of African heritage have a
hemolytic discase or other pathology in the
milar condition called transient
newborn. Jaundice that appears in full tem onatal pustular melanosis.
newborns 24 hours after birth and peaks at 72
hours. Bilirubin may reach 6 to 10 mg/dl and
 resolve in 5 to 7 days.
o Ifjaundice occurs within 2 days pathologic
Jaundlce
o Ifjaundice occurs at 3rd-7th days of life -

physlologle Jaundice

Erythema toxicum The size & shape vary, but it commonly appears
Is an eruption of lesions in the on the face. It does not grow in size, does not
area surrounding a hair follicle fade in time and does not blanch. The birthmark
that are fim, vary in size from maybe concealed by using an opaque cosmetic
1-3 mm, and consist of a cream.
white or pale ycllow papule or I f convulsions and other neurologic problem
pustule w/ an erythematous
accompany the nevus flammeus,--5th
base.
cranlal nerve involvement.
o It is often called "newborn r h" or "fleabite"
dermatitis Nevus vasculosus (strawberry mark)
o The rash may appear suddenly, usually over A capillary hemangioma,
o the trunk and diaper arca and is frequently consists ofnewly formed and
widespread. enlarged capillaries in the
O The lesions do not appear on the palms of the dermal and subdermal layers.
hands or soles of the feet. It is a raised,clearly delineated,
o The peak incidence is 24-48 hours of life. dark-red, rough-surfaced
o Cause Is unknown and no treatment
birthmark commonly found in
the head region.
Harlequin Sign
o The color of the newborn's body appears to be
half red and half pale. This condition is
transitory and usually occurs with lusty crying. Such marks usually grow starting the second or
Harlequin Coloring may be associated with to third weck of life and may not reach their
an immature vasomotor retlex system. fullest size for I to 3 months; disappears at the
age ofI yr. but as the baby grows it enlarges.
Birthmarks frequently worry parents. The
BIRTH MARKS
mother maybe especially anxious, fearing that
she is to blame ("ls my baby marked because of
Telangiectatic nevi (stork bites)
something I did?") Guilt feclings are common
Appear as pale pink or red spots and are when parents have misconceptions about the
cause. Identity and explain them to the parents.
frequently found on the eyelids, nose, lower
occipital bone and nape of the neck Providing appropriate information about the
cause and course of birthmarks often relieves
These lesions are common in NB w/ light
the fears and anxieties of the family. Note any
complexions and are more noticeable during
bruises, abrasions,or birthmarks seen on
periods oferying. admission to the nursery.
HEAD
Head circumference should be 2 cm greater
than chest circumference
Stonk bite
Assess fontanclles and sutures - observe for

signs of hydrocephalus and evaluate neurologic

status
Craniosynostosis
Microcephaly
. Macrocephaly
3 types Hemanglomas
a.) Nevus Flammeus p o r t wine stain - macular purple
-***
or dark red lesions seen on face or thigh. NEVER
disappear. Can be removed surgically
b.) Strawberry hemangiomas-nevus vasculosus
dilated capillaries in the entire dermal or subdermal
arca. Enlarges, disappears at 10 yo,.
c.) Cavernous hemangiomas - communication network

of venules in SQ tissue that never disappcar

with a

Flammeus (port-wine stain)

A capillary angioma directly below the
epidermis, is a non-clevated, sharply
demarcated, red-to-purple area of dense
capillaries.
Macular purple
 TABLE 27-3 *
Compardson of
CApUt SICCPOanounm

Cephalhematoma
Collecton of blbod betheen cranial (usualy parietal) bone and
elmembrane

t h crying
Appears on trst and second day
Dsappears ater 2 to 3 weeks or may take monDhs

Capt beceea
ematous seling af the soalp
Croses uture ines
Pesert at birth or shorty thereater
Reaboarbed wthin l2 oun or a d a y s a n DE

Face, Mouth, Eyes, and Ears Eplspadias: if the opening is at the dorsal
Assess and record symmetry surtace
ASsess tor signs of Down syndromc. Hydrocele- swelling due to accumulation of
Low set ears serous fluid in the tunica vaginalis of the testis
Assess history for risk factors of hearing loss or in the spermatic cord
Test for Moro reflex- elicited by a loud noise or
Anus
lifted slightly above the crib and then suddenly
lowered. In responsc, the NB straightens arms Inspect anal arca to verify that it is patent and
and hands outward while the knees flexed. has no fisure
Slowly the arm returns to the chest as in Digital exam by physician or nurse practitioner
embrace. The fingers spread, forming a C and if needed
the newborn may cry. This lasts up to 6 months Note passage of meconium
Extremities

Check for presence of gag. swallowing T i c dwarfism:

reflexes, coordinated with sucking reflex
very shortarms
Amelia : absence of arms
Check for clefts in cither hard or soft palates
Phocomelia: absence of long arm
Check for excessive drooling
Polydactilism: more fingers; extra digits on
Chcck tongue for deviation, white cheesy cither hands or feet
coating Syndactilism: webbing; fusion of fingers or
Eyes
tocs
Assess for PERLA (puplls equal and reactive
to light and accommodation)
Inspect the hands for normal palmar creases. A
Assess cornea and blink reflex
single palmar crease called SIMIAN line is
Note true eye color does not occur before 6
frequently present in Down's syndrome
months
May have blocked tear duct
Adactyl no foot
Heart and Lungs
Down's syndrome: inward rotation of little
Assess and maintain airway fingers
Assess heart rate, rhythm - evaluate murmur: Clubfoot/ talipes deformity-inward rotation
location, timing, and duration of foot fingers.
o Examine appearance and size of chest Erb-Duchenne paralysls (Erb's palsy):
o Note if there is funnel chest., barrel resulting from injury to the Sth and 6th cervical
chest, unequal chest expansion roots of the brachial plexus; usually from a

Assess breath sounds and respiratory eftorts difficult birth; it occurs commonly when strong
traction is exerted on the head of the NB in an
evaluate color for palor or cyanosis
Breasts are flat with symmetric nipples - note attempt to free a shoulder lodged behind the
symphysis pubis in the presence of shoulder
lack of breast tissue or discharge
dystocia
Abdomen
Abdomen appcars large in relation to pelvis
o Note increase or dccrease in peristalsis |4. The asymmetry of gluteal
Note protrusion of umbilicus and thigh fat folds see
Measure umbilical hermia by palpating the
opening and record

o Note any discharge or oozing from

cord
N o t e appearance and amount of B. Barlow's (dislocation)
vessels maneuver. Baby's thigh is
Auscultate and percuss abdomen grasped and adducted
o Assess for signs of dehydration (placcd together) with
oAssess femoral pulses gentle downward
Note bulges in inguinal area
o Percuss bladder l to 4 cm above
symphysis
o Voids within 3 hours of binth or at timne
of birth
Genitals
Pseudomenstruation: the discharge w/c can
 become tinged w/ blood and is caused by
withdrawal or C. Dislocation is palpable
maternal hormones as femoral head slips out of
acetabulum.
Smegma: a white cheeselike substance is often
present between labia. Removing it may
traumatize tender
tissue
D. Ortolani's maneuverputs
Phimosis: tight foreskin or prepuce; w/c downward pressure on the hip and
sometimes Icad to early circumcision
then inward rotation. If the hip is
dislocated, his
Cryptoorchidism: undescended testes :if the
maneuver forces the femoral head
testes did not go down
over the acetabular rim
Orchidopexy: repair of undescended testes
before 2 y/o Clubfoot
Penls: urethra should be at the tip of the penis O Nurse examines feet for evidence of talipes deformity
Hypospadias: if the opening is at the ventral
Surlace
(clubfoot)
o Intrauterine positions can causc feet to appcar to turn
inward- "positional" clubfoot
o To determine presence of clubfoot, nurse moves foot to
midline if resists, it is true clubfoot
TALIPES-"clubfoot"
a.) Equinos plantar flexion -horsefoot
Babinskl reflex When
sole of the foot is firmly
-

th
b.) Calcaneous - dorsiflexion -heal lower that
stroked,the big toe bends
foot anterior posterior of foot flexed towards
back toward the top of the
anterior leg
foot and the other toes
c.) Varus- foot turns in fan
out. This is a normal
d.) Valgus- foot turns out reflex
up to about 2 years of age.
Equino varus- most common

Tonic neck reflex - When a

Tomc baby's head is turmed to one
neck side, the arm on that side
reflex stretches out and the opposite
arm bends
up at the elbow. This is often
called the "fencing" position.
Nursing Role
he tonic neck relex lasts
Be knowledgeable about normal newborn about six to seven months.
variations and responses that indicate further
investigation
O Respiratory distress

o Central cyanosis Grasp reflex - Stroking the

Thermoregulation problems palm of a baby's

hand
Grasp
Dehydration causes
the baby to
reflex
close his/her fingers in
Teaching
a grasp. Ihe grasp retlex
During physical and behavioral assessment,
lasts only a couple of
identify family's need for teaching
Involve family carly in care of infant onns and is stronger in
premature babies.
o Proccss establishes uniqueness and
Palmar& Plantar
allays concern
Teaching
O Feeding cues Palmar & Plantar Grasp Reflex
O Alert state

Cord care
o Sleeping

Neurological Status
Assessment begins with period of observation
Observe bchaviors - note:

State of alertness
o Resting posture
O Cry
The Moro rellex is often called a
o Quality of muscle tone
startle retlex because it usually occurs
when a baby is startled by a loud
Motor activity
sound or movement. In response lo
Jitteriness-feeling of extreme nervousness the sound, the baby throws back
Diferentiate causative factors his/her head.
extends out the arms and legs, cries,
Examine for symmetry and strength of
then pulls the arms and legs back in.
movements A baby's own cry can startle
him her
Note head lag of less than 45 degrees
and begin this retlex. This reflex lasts
about ive to six months.
Assess ability to hold hcad erect briefly
 Immature central nervous system (CNS)
of
newborn is characterized by varicty of reflexes
This reflex is also
Somec reflexes are protective. some aid Step reflex
the walking dance
in fecding. others stimulate interaction called or

reflex because a baby appcars to

Assess for CNS integration
take steps or dance when held
Protcctive reflexes are blinking. yawning.
coughing, sneczing, drawing back from pain
upright with his/her fcet touching
solid
Rooting and sucking reflexes assist with
Surface.
feeding
What reflexes should be presentin a newborn? Reflexes are
mvoluntay movemenis or actions. Some movemens are sponianeous meo
occiurrng as part of h e bany's usuai activty Ohers are responses to

Ccertan actions. Kefleexes help laeniy nornma bram and nervea ctvity
Some rejlexes occur ony in specijic perlods of development. Ihe

Joiowng are some h e nornmal rejlexes seen m newbom babies

B. The clitoris is still

Root rellex- This reflex begins when
he cornerot the baby's mouth is visible. The labia minora
are now covered by the
stroked or touched. The baby will turn
her larger labia majora. Score
his head and open his/her mouth to
follow and 2. The gestational ageis
roo" in the direction of the stroking. 36 to 40 wecks.
YTH helps the babyfind the breast or
bottle to begin feeding.

Suck reflex Rooting helps the

baby become ready to C. The term newborn has
suck. When the roof of the baby's well-developed, large
mouth is labia majora that cover
touched. the baby will begin to both clitoris and labia
suck. This retlex does not begin
minora. Score 3.
until about the 32nd
is not
week of pregnancy and
fully developed until about so
weeks. Premature babies may
have a weak or immature suckingg Neuromuscular Components
ability because of this. Babies also
nave a hand-to mouth reflex that
Square window sign
gOes with rooting and sucking and
may suck on tingers or hands. A, This angle is 90
degrees and suggests an
immature
newborn of 28 to 32
ASSESSMENT OF PHYSICAL MATURITY
wccks' gestation. Score
CHARACTERISTICS OF NEWBORN
).
Observable characteristics of newborm should
be evaluated while not disturbing baby
Gestational assessment tools examine the
following physical characteristics
o Resting posture
B, A 30-to
Skin 40-degree
angle is commonly found
Lanugo Irom 39 to 40 weeks'
o Sole (planar) creases gestation. Score 2-3.

oBreast tissue
Ear form and cartilage distribution
Evaluation of genitals

Male genitals CA 0-degree angle can

occur from 40 to 42 weeks.
Used with
Score 4. (C)
permissionfrom
.Dubowitz, MD.
Hammersnmith Hospital
London, Englana.

A, Preterm newborn's testes are not within the scrotum.

The scrotal surface has few rugac. score
2. Signs of Preterm Bables
 o Born after 20 weeks, after 37 weeks
Ofrog leg or laxed positon
hypotonic muscle tone- prone resp problem
O

o
Scart sign-elbow passes midline pos.
square window wrist-90 degree angle of wrTIst
O heal to ear signabundant lanugo-

Signs of Post term babies:

>42 weeks
o classic sign - old man's face
B, Term newborm's testes are generally fully descended. o desquamation -peeling of skin
The entire surface of the scrotum is covered by rugae. o long brittle finger nails
Score 3. O wide &alert eyes
Female genitals
A, Newborn has a prominent Bables with speclal needs
Some babies may need some extra aftention from jou and the doctor
clitoris. The labia majora are
after birth.
widely separatcd, and the These include:
Low birth
o weight babies (less than 2.5kg).
labia minora, viewed o Babies born too carly (premature).
laterally, would protrude o Babies with pathological jaundice.
beyond the labia majora. o Babies with iniection.
Score. The gestational age o Those needing an operation soon after birth.
is 30 to 35 weeks. o Those with low blood sugar.
Babies of diabetic mothers.